Frontiers in digital health · 2026
Co-designing embodied extended reality telehealth for veteran mental health: from movement care to whole health.
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Elor Aviv, Kuznetsov Maxim, Kusumoto Laura, Duval Jared, Burnett Kedron, Skelton Felicia, Touchett Hilary
Аннотация
INTRODUCTION: Veterans in rural and underserved communities face persistent care barriers from provider shortages, travel burdens, and the digital divide. Within the Department of Veterans Affairs (VA), the Clinical Resource Hub (CRH) National Telehealth Program delivers primary, mental health, specialty, surgical, and rehabilitative care into veterans' homes and rural clinics, while VA Immersive scales extended reality (XR) across the system. Embodied XR telehealth, where provider and patient meet as full-body avatars in a shared immersive environment, intersects these programs and introduces new design requirements. This study extends our embodied XR codesign series from physical rehabilitation to mental health and whole health.
METHODS: Stakeholders from VA, academia, and industry ( N = 30 ), drawn from Boise and other participating CRHs, joined a 3-day codesign at the Boise VA Medical Center in June 2026, including shadowing telehealth workflows, a full-day workshop with five teams, and a half-day debrief with program leads. Seven usability task ratings, 164 four-axis ideas (Raise, Reduce, Eliminate, Create), 95 debrief proposals, 188 prioritization votes, and 19 discussion transcripts were analyzed through descriptive statistics and reflexive thematic analysis.
RESULTS: Perceived task ease was high among a cohort with mixed VR experience across seven tasks (tutorial, joining a telehealth room, exercise completion, movement recording, environment and interactable customization, and spatial drawing), each above 4.1 of 5 on the Single Ease Question, led by customizing virtual environments ( M = 4.84 ± 0.37 ). Stakeholders most endorsed minimalist defaults, onboarding resources, and out-of-the-box readiness, followed by embodiment with personalized environments, disability representation, and veteran identity markers. The debrief prioritized breathing and grounding, graded exposure, psychoeducation, and whole-health movement, delivered through headsets paired to an in-clinic tablet or monitored home deployment. Infrastructure compatibility, workforce fit, and governance emerged as pervasive constraints. Workshop satisfaction was high ( M = 4.82 ± 0.53 of 5) with 88% requesting follow-up; platform-specific ratings were favorable but lower and more variable (e.g., user-friendliness M = 3.76 ± 0.97 of 5).
DISCUSSION: We propose candidate design principles for extending an embodied XR telehealth platform, built for physical rehabilitation, to mental health and whole health care for veterans, and discuss implications for platform design, piloting, and deployment.
METHODS: Stakeholders from VA, academia, and industry ( N = 30 ), drawn from Boise and other participating CRHs, joined a 3-day codesign at the Boise VA Medical Center in June 2026, including shadowing telehealth workflows, a full-day workshop with five teams, and a half-day debrief with program leads. Seven usability task ratings, 164 four-axis ideas (Raise, Reduce, Eliminate, Create), 95 debrief proposals, 188 prioritization votes, and 19 discussion transcripts were analyzed through descriptive statistics and reflexive thematic analysis.
RESULTS: Perceived task ease was high among a cohort with mixed VR experience across seven tasks (tutorial, joining a telehealth room, exercise completion, movement recording, environment and interactable customization, and spatial drawing), each above 4.1 of 5 on the Single Ease Question, led by customizing virtual environments ( M = 4.84 ± 0.37 ). Stakeholders most endorsed minimalist defaults, onboarding resources, and out-of-the-box readiness, followed by embodiment with personalized environments, disability representation, and veteran identity markers. The debrief prioritized breathing and grounding, graded exposure, psychoeducation, and whole-health movement, delivered through headsets paired to an in-clinic tablet or monitored home deployment. Infrastructure compatibility, workforce fit, and governance emerged as pervasive constraints. Workshop satisfaction was high ( M = 4.82 ± 0.53 of 5) with 88% requesting follow-up; platform-specific ratings were favorable but lower and more variable (e.g., user-friendliness M = 3.76 ± 0.97 of 5).
DISCUSSION: We propose candidate design principles for extending an embodied XR telehealth platform, built for physical rehabilitation, to mental health and whole health care for veterans, and discuss implications for platform design, piloting, and deployment.